ICSC WESTERN CONFERENCE & DEAL MAKING
September 16 – 18, 2015 | San Diego Convention Center | San Diego, CA
Sports Event Sign-Up Form
Return Completed Form and Payment to
ICSC Registration
P.O. Box 26958
New York, NY 10087-6958
Tel: +1 646 728 3800
Fax: +1 732 694 1800
Checks must be made payable to ICSC.
When
Wednesday, September 16, 2015
9:30 am – Registration
10:00 am – Shotgun Start
Where
Salt Creek Golf Club
525 Hunte Parkway
Chula Vista, CA
Please allow 10 days to process any payments made by check.
Golf Contact
Mark McDonald
First American Title Insurance Company
Tel: +1 858 410 3871
E-mail: [email protected]
Fees
$125 (non-refundable) per player via check made payable to ICSC. Fee
includes green fees, cart, range balls and lunch (golf club rental extra).
Please Note: Space is limited to 100 players and will be confirmed on a first-come,
first-served basis. Players must receive confirmation prior to play. Online registration
is available for individuals ONLY. If you wish to register a foursome, please mail or
fax in your registration with payment. Please pre-arrange your foursome.
Golf Sponsor Contacts
Pat Lindahl
Eleven Western Builders, Inc.
Tel: +1 760 796 6346 x233
E-mail: [email protected]
ICSC Contact
Ariel Kattan
Tel: +1 646 728 3554
E-mail: [email protected]
Gregory Pico
NAI San Diego
Tel: +1 619 241 2363
E-mail: [email protected]
This form should be duplicated for additional registrations.
Name Company
Golf
Preferred Foursome:
Address
1._________________________________
City
State/Province
Zip/Postal Code
2._________________________________
3._________________________________
Telephone Fax
4._________________________________
E-mail
Your Membership I.D. #
Method of Payment
Check made payable to ICSC enclosed for
MasterCard
Visa
AMEX
$
Discover
$
Name (as it appears on credit card)
Signature
Credit Card Number (include all digits)
Expiration Date (month/year)
Release of Claims (Read Carefully and Sign)
I agree and acknowledge that I am participating in
the ICSC Golf Tournament (“Sports Event”) on my own
accord. I give this acknowledgment freely and knowingly
and I represent and warrant to you that I am physically and
mentally fit and that, as a result, able to participate, and I
do hereby assume responsibility for my own well-being.
I am fully aware that possible physical injury
might occur to me as a result of my participation, and I
agree to assume the full risk, including risk which is not
specifically foreseeable, of any injuries, including death,
damages or loss regardless of severity, which I may
Signature
Print Name
sustain as a result of participating in any and all activities
connected with or associated with the Sports Event.
In consideration of the right to participate in the
Sports Event, I hereby waive any and all rights or claims
I may have as a result of participation in the Sports Event
against the International Council of Shopping Centers,
Salt Creek Golf Club, and their respective directors,
officers, employees, members, staff, and all individuals
assisting in instructing, sponsoring and conducting these
activities, and I hereby fully release and discharge them
from any and all claims resulting from injuries, including
death, damages or loss, which may accrue to me or my
Note: Please coordinate your choices with each other.
Net Division:
Gross Division:
__________ or
Established Handicap:
__________ or
Estimated Handicap:
____________
(Check one only – copy this form for additional events)
heirs arising out of or in any way connected with my
participation in the Sports Event.
I further agree to indemnify, defend and hold
harmless the International Council of Shopping Centers,
Salt Creek Golf Club and their respective directors,
officers, employees, members, staff, and all individuals
assisting in instructing, sponsoring and conducting these
activities, from any and all claims resulting from injuries,
including death, damages or loss, which may accrue to
me or my heirs arising out of or in any way connected
with my participation in the Sports Event.
Date
13
__________ or
2015WS-B